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Ann Thorac Surg 2003;75:2007-2008
© 2003 The Society of Thoracic Surgeons

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Correspondence

Tissuemed porcine bioprosthesis

^a Cardiac Surgery Unit, Hospital Clínico Universitario, Choupana suhMedicine School, Santiago de Compostela, Spain

e-mail: jsierraq{at}teleline.es

To the Editor:

We read with interest the article by Goldsmith and colleagues [1]. This excellent article describes the midterm clinical performance of the Tissuemed porcine prosthesis. The conclusions are that the Tissuemed prosthesis is a safe and reliable heart valve with low complication rates at 8 years follow-up.

Several questions remain related to the experience reported by Goldsmith and associates.

First, the mean age for the whole cohort was 73 ± 3 years (range, 42 to 93 years). The overall mortality and long-term survival was assessed by patient age stratification in two groups: younger and older than 70 years. Nevertheless, events such as valve-related complications were not assessed according to age group. It is possible that age stratification could be of some value to study the occurrence of valve-related complications.

Second, there were no cases of structural valvular deterioration. Follow-up of the patients was conducted only by clinical review, postal questionnaire, or telephone contact. Moderate degrees of valvular dysfunction causing stenosis or regurgitation may be present in asymptomatic patients 75 years or older, and an echocardiographic scan would demonstrate structural valve deterioration.

Third, actuarial estimation of survival according to age, valve position, and valve size should indicate the standard error of the estimate and the number of patients remaining at risk at shorter intervals (eg, how many patients are at risk at 7 years follow-up?, at 8 years follow-up only 2 patients, one AVR and one MVR, are at risk). Curves should not be extrapolated beyond time frames containing very few patients.

References

1. Goldsmith I.R.A., Spytz T.J., Boehm M., Kendall I., Rosin M.D. Midterm evaluation of the Tissuemed (Aspire) porcine bioprosthesis: 493 patients, 506 bioprostheses. Ann Thorac Surg 2001;71:1471-1476.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sierra, J. Articles by García-Bengochea, J. Search for Related Content PubMed PubMed Citation Articles by Sierra, J. Articles by García-Bengochea, J.